Individual-level Risk Research Articles

Data-Driven Decision Support Tool Co-Development with a Primary Health Care Practice Based Learning Network

Background The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities’ Practice Based Learning Network (PBLN) data-driven decision support tool co-development project. Methods We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data. We summarize our work to date in terms of six stages: population-level descriptive-exploratory study, PBLN team engagement, decision support tool problem selection, sandbox case study 1: individual-level risk predictions, sandbox case study 2: population-level planning predictions, project recap and next steps decision. Results The population-level study provided an initial point of engagement to consider how clients are (not) represented in EHR data and to inform problem selection and methodological decisions thereafter. We identified three initial meaningful types of decision support, with target application areas: risk prediction/screening, triaging specialized program referrals, and identifying care access needs. Based on feasibility and expected impact, we started with the goal to support earlier identification of mental health decline after diabetes diagnosis. As discussions deepened around clinical use cases associated with example prediction task set ups, the target problem evolved towards supporting the upstream task of organizational planning and advocacy for adequate mental health care service capacity to meet incoming needs. Conclusions This case study contributes towards a tool to support diabetes and mental health care, as well as lays groundwork for future CHC EHR-based decision support tool initiatives. We share lessons learned and reflections from our process that other primary health care organizations may use to inform their own co-development initiatives.

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model.

To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. There is a need for further research on the complex, overlapping risk environments ofracial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

Adverse childhood experiences, individual-level risk and protective factors, and recent drug use in a community sample of Nigerian women.

Adverse childhood experiences (ACEs) are associated with a wide range of health problems and health-compromising behaviors, including drug use, but are understudied in sub-Saharan Africa. Further, some data suggest that some types of ACEs are more strongly associated with outcomes than others. We investigated associations between different types of ACEs and recent drug use among 2,011 women living in Katsina State, Nigeria. This community-based survey included questions on ACE exposure, modifiable individual-level risk and promotive factors, and past-year drug use. Tobacco, cannabis, and the nonmedical use of cough syrup with codeine and tramadol were the most frequently used drugs. Logistic regressions revealed that across most drugs, ACEs reflecting abuse, neglect, and household dysfunction, but not community violence, increased the likelihood of drug use, odds ratios (ORs) = 1.30-3.10. Ease of access to drugs, ORs = 1.33-2.98, and personal religiosity, ORs = 1.19-2.27, also enhanced the risk of drug use, and higher depressive affect was associated with codeine, OR = 1.27, and tramadol use, ORs = 2.42. Practicing religious rites, ORs = 0.38-0.70; disapproval of drug use, ORs = 0.36-0.57; and perceived harm from drug use, ORs = 0.54-0.71, reduced the likelihood of drug use. Efforts to prevent abuse, neglect, and household dysfunction; reduce access to drugs; treat depression; and increase disapproval and harm associated with drug use may reduce drug use in the context of ACE exposure.

Examining Individual and Contextual Correlates of Victimization for Juvenile Human Trafficking in Florida.

Despite extant literature on individual-level risk factors for sex trafficking among children and adolescents, little is known about the impact of social and ecological contexts on risk of human trafficking victimization. The purpose of this study was to examine the correlates signaling risk of human trafficking victimization at the individual, family, social, and community levels utilizing a sample of 40,531 justice-involved male and female youth, a small fraction of whom were suspected or verified victims of human trafficking between 2011 and 2015 (N = 801, including 699 female and 102 male youth). Using this sample, we examined differences across individual, family, social, and community characteristics of youth involved in the juvenile justice system who have a history of trafficking victimization and youth without such histories. Series of logistic regression analyses were conducted using varying control groups, created through exact matching and randomized matching groups to address sample imbalances. These analyses indicate that, at the individual level, youth who had experienced childhood adversities were more likely to report human trafficking victimization. Sex differences were found regarding risk factors pertaining to the family and broader socio-ecological contexts. Female youth who had witnessed family violence had an antisocial partner or antisocial friends, or resided in a community with a greater proportion of the population being foreign-born or speaking English less than very well were at heightened risk for human trafficking victimization. Little evidence was found for community-level risk factors of victimization in this specific sample of justice-involved youth. These findings encourage more research to unpack the multilevel correlates of victimizations at the individual, family, social, and community levels, recognizing potential differences between female and male youth regarding the factors that put them at heightened risk for juvenile sex trafficking victimizations. Practice and policy should direct awareness and prevention measures to social and ecological contexts.

A study exploring regional level predictors of suicide rates across time in Sweden

AbstractIntroductionIn Sweden, four lives are lost to suicide each day. Hence, identifying relevant risk factors to inform effective prevention strategies is key. Such strategies can range from individual (‘micro’) -level prevention methods, to broader national suicide prevention policies.ObjectivesWhilst a range of studies have explored individual-level risk factors, highlighting municipal, regional, or national-level predictors can be valuable to identify broader social and contextual determinants. This study will therefore aim to go beyond proximal predictors of suicide by looking through a wider national- and regional-level lens in Sweden.MethodsThis project will be conducted utilizing routinely collected and publicly available data and applying longitudinal modelling to investigate potential predictors of changes in suicide rates across time in Sweden. More specifically, the study will explore whether regional data on economic (e.g. proportion of state benefit recipients), socio-demographic (e.g. educational level) and healthcare related variables (e.g. trust in the healthcare system) are associated with suicide rates over time.ResultsThis is an ongoing project and results will be available and presented at the time of the conference.Conclusions Utilizing publicly available data to explore potential predictors of suicide rates is not only cost-effective, but adding such findings to existing knowledge of individual-level risk factors can also be important when targeting wider policy and ensuring effective coordination and implementation of regional suicide prevention strategies.Disclosure of InterestNone Declared

Regional European genetic ancestry predicts type I interferon level and risk of severe viral infection.

Viral infection outcomes vary widely between individuals, ranging from mild symptoms to severe organ failure and death, and it is clear that host genetic factors play a role in this variability. Type I interferon (IFN) is a critical anti-viral cytokine, and we have previously noted differences in type I IFN levels between world populations. In this study, we investigate the interrelationship between regional European genetic ancestry, type I IFN levels and severe viral infection outcomes. In cohorts of European ancestry lupus patients living in Europe, we noted higher IFN in the Northwestern populations as compared to Southeastern populations. In an independent cohort of European ancestry lupus patients from the USA with varying proportional regional European genetic admixture, we observed the same Northwest vs. Southeast European ancestry IFN gradient. We developed a model to predict type I IFN level based on regional European ancestry (Area under the curve (AUC) = 0.73, P = 6.1e-6). Examining large databases containing serious viral outcomes data, we found that lower predicted IFN in the corresponding European country was significantly correlated with increased viral infection fatality rate, including Coronavirus Disease 2019 (COVID-19), viral hepatitis and HIV [correlation coefficients: -0.79 (P = 4e-2), -0.94 (P = 6e-3) and -0.96 (P = 8e-2), respectively]. This association between predicted type I IFN level and viral outcome severity suggests a potential causal relationship, as greater intrinsic type I IFN is beneficial in host defense against viruses. Genetic testing could provide insight into individual and population level risk of fatality due to viruses prior to infection, across a wide range of viral pathogens.

Abstract 34: Social Risks, Glycemic Control and Elevated Blood Pressure Among Patients With Diabetes in the Ascension Health System

Background: Calls to address social risks have stimulated interest in integrating screening measures into the electronic medical record (EMR) - particularly, self-reported individual level social risks - to improve care for chronic diseases like diabetes (DM). Objective: Examine associations between individual-level social risks and glycemic control and elevated blood pressure (BP) among patients with DM in the Ascension Health System. Methods: A 10-item EMR-embedded survey [access to care, resources, transportation, employment] was collected in Ascension primary care clinics in 12 U.S. states. Neighborhood-level risk was characterized with the CDC Social Vulnerability index (SVI) by census tract of patients’ residences. Associations between social risk (individual/composite) and uncontrolled DM (HbA1c >9%) and elevated BP (>120/80) adjusting for age, sex, race/ethnicity, SVI, region, and chronic conditions were examined. Results: Among 75,848 patients with DM and social risk data available [median age 62, 53% female, 22% Black, 7.5% Hispanic]. 20% had poor glycemic control; 27% had elevated BP; 20% lived in a high SVI census tract. Patients identifying any social risk were more likely to have poor glycemic or elevated BP. Patients with the highest social risk scores had higher odds of uncontrolled glycemia (OR 1.72, 95% CI 1.60-1.85) and elevated BP (OR 1.18, 95% CI 1.10-1.26). Conclusion: Examination of a large sample of primary care patients in a large multi-region health system determined that individual-level social risks were correlated with glycemic and BP control. These data highlight the need to simultaneously address social risks and medical conditions to impact population health.

Exploring longitudinal relationships between fitness tracking and disordered eating outcomes in college-aged women.

A growing body of research, primarily cross-sectional, suggests a relationship between the practice of tracking one's food intake and exercise behaviors using fitness-tracking smartphone applications ("apps") or wearable devices ("wearables") and disordered eating symptomatology. The aim of the present study was to explore longitudinal relationships between fitness tracking and disordered eating outcomes among college-aged women, as well as to determine whether the individual-level risk factors of pre-existing eating concerns, perfectionism, and rumination about food moderated the relationship. N = 68 female undergraduates used the MyFitnessPal app for 8 weeks while completing a series of self-report measures. At the trait level, fitness tracking frequency was positively associated with weight/shape concerns, but not with the other outcome measures. Daily levels of fitness tracking did not predict next-day levels for any of the outcome measures. Within-day fitness tracking at one timepoint was associated with lower reports of dietary restraint efforts at the next timepoint. None of the proposed moderators significantly interacted with the relationships over time. These results suggest that while those who engage in fitness tracking may experience higher weight/shape concerns as a trait, over time fitness tracking was not associated with an increase in concerns. Further work exploring whether fitness tracking may affect particular subgroups in different ways is warranted.

Familial hypercholesterolaemia: a genetic condition with associated cardiovascular risk

Familial hypercholesterolaemia is a common genetic condition that affects the liver's ability to clear low-density lipoprotein cholesterol from the bloodstream. It affects around one in 250 individuals and is characterised by elevated lipid levels from birth. The causal relationship between raised lipids and cardiovascular disease is well established and the impact of this is evident in familial hypercholesterolaemia. These individuals find themselves at increased risk of premature cardiovascular events as a result of the cumulative lifetime burden of excess cholesterol in the bloodstream. Most individuals with familial hypercholesterolaemia remain undiagnosed and therefore untreated. Early detection and treatment of familial hypercholesterolaemia provides an opportunity to initiate cardiovascular risk prevention, which can reduce the individual's level of risk to that of the general population. Increasing nurses' genetic knowledge and raising awareness of conditions such as familial hypercholesterolaemia can help to improve current rates of detection and provide nurses with the necessary skills to recognise and support patients and their families.

Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival.

Socioeconomic inequities have implications for access to health care and may be associated with disparities in treatment and survival. To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous-cell carcinoma. This is a retrospective study using a nationwide data set. The patients were selected from the National Cancer Database and enrolled from 2004 to 2016. We identified patients with stage I to III squamous-cell carcinoma of the anus who were treated with chemoradiation therapy. Socioeconomic factors, including race, insurance status, median household income, and percentage of the population with no high school degrees, were included. The association of these factors with treatment delay and overall survival was investigated. A total of 24,143 patients who underwent treatment for grade I to III squamous-cell carcinoma of the anus were identified. The median age was 60 years, and 70% of patients were women. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, patients with a higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late-treatment group had worse overall survival compared to the early treatment group (98 vs 125 months; p < 0.001). No detailed information is available about the chemoradiotherapy regimen, completion of treatment, recurrence, disease-free survival, and individual-level socioeconomic condition and risk factors. Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract . ANTECEDENTES:Las desigualdades socio-económicas tienen implicaciones en el acceso a la atención médica y pueden estar asociadas con disparidades en el tratamiento y la sobrevida.OBJETIVO:Indagar el impacto de las desigualdades socio-económicas sobre el tiempo de retraso en el tratamiento y la sobrevida en casos de carcinoma a células escamosas del ano (CCEA).DISEÑO:Estudio retrospectivo utilizando un conjunto de datos a nivel nacional.AJUSTES:Todos aquellos pacientes inscritos entre 2004 a 2016 y que fueron seleccionados de la Base Nacional de Datos sobre el Cáncer.PACIENTES:Identificamos pacientes con CCEA en estadíos I-III y que fueron tratados con radio-quimioterápia.PRINCIPALES MEDIDAS DE RESULTADOS:Se incluyeron factores socio-económicos tales como la raza, el tipo de seguro de salud, el ingreso familiar medio y el porcentaje de personas sin bachillerato de secundaria (SBS). Se investigó la asociación entre estos factores con el retraso en iniciar el tratamiento y la sobrevida global.RESULTADOS:Se identificaron un total de 24.143 pacientes que recibieron tratamiento para CCEA estadíos I-III. La mediana de edad fue de 60 años donde 70% eran de sexo femenino. La mediana del tiempo transcurrido desde el diagnóstico hasta el inicio del tratamiento fue de 33 días. Los pacientes residentes en zonas de código postal con ingresos medios más bajos, con un mayor porcentaje de individuos SBS y los pacientes con otro tipo de seguro gubernamental de salud, seguidos del seguro tipo Medicaid iniciaron el tratamiento solamente después de 60 días al diagnóstico inicial de CCEA. El análisis de Kaplan-Meier de la sobrevida mostró que el grupo de tratamiento tardío tuvo una peor supervivencia general comparada con el grupo de tratamiento precoz o temprano (98 frente a 125 meses; p <0,001).LIMITACIONES:No se dispone de información detallada sobre el tipo de radio-quimioterapia utilizada, ni sobre la finalización del tratamiento o la recurrencia, tampoco acerca de la sobrevida libre de enfermedad ni sobre las condiciones socio-económicas o aquellos factores de riesgo a nivel individual.CONCLUSIÓN:Los pacientes de comunidades con ingresos medios más bajos, con un nivel de educación limitado e inscritos en un seguro público tardaron mucho más tiempo en recibir el tratamiento prescrito. El nivel socio-económico más bajo también se asoció con una sobrevida global más baja. Los presentes resultados justifican mayor análisis y medidas mas importantes para mejorar el acceso a la atención en salud y poder afrontar esta disparidad. (Traducción-Dr. Xavier Delgadillo ).

Risk assessments of virtual interactions on Saudi families

Family relationships are the basis for a stable family atmosphere. Now with the internet, which has become a tangible part of our lives, membership of virtual communities, including social networks, has grown. It has created fundamental changes in the structure of social relationships and human interaction, forming a new framework of virtual interactions that transcend international borders. Due to their significance, unavoidability, availability, confidentiality, ease of use, and intrusive nature through interaction and sharing, virtual communities now extend beyond the individual and related level of risk. This study aimed to assess the cultural and behavioral risks of virtual interactions for Saudi families and their level of incidence and likelihood. It belonged to descriptive studies, using the social survey for a sample (1524) from Hail region families between 15 December 2022 and 31 January 2023, and was based on the list of cultural and behavioral risks of virtual interactions. Results showed that the most dangerous social networking sites for Saudi families were TikTok, Twitter, Snapchat, YouTube, and Instagram respectively. Matrix results showed that 66.7% of virtual interaction threats have a high severity and likelihood, namely: adopting atheistic ideas, spreading the thought of hate, undermining the values of the Saudi family, and adopting ideas that incite violence from cultural threats, privacy hacks, cyber-bullying, fraud, violence, social isolation and cybercrime from behavioral threats. The study recommends adopting a social risk management (SRM) concept, especially regarding risks to family, because it is a new dimension of social protection.

Vulnerable newborn phenotypes in Peru: a population-based study of 3,841,531 births at national and subnational levels from 2012 to 2021

We aimed to examine the national and subnational prevalence of vulnerable newborn phenotypes in Peru, 2012-2021. Newborn phenotypes were defined using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight [LBW], non-LBW) using the Peruvian National Birth Registry as six (by excluding birthweight) and ten newborn phenotypes (using all three outcomes). Small phenotypes (with at least one classification of PT, SGA, or LBW) were further considered. Using individual-level data, we stratified the phenotypes by maternal educational level, maternal age, healthcare insurance, altitude of residence, and geographic region (Coast, Andes, and Amazon). The prevalence of the five vulnerable newborn phenotypes for the study period was LGA+T (15.2%), AGA+PT (5.2%), SGA+T (4.6%), LGA+PT (0.8%), and SGA+PT (0.7%). The Coast had a higher prevalence of newborns with large phenotypes (19.4%) and the Highlands a higher prevalence of newborns with small phenotypes (12.5%). Mothers with poor socioeconomic status, extreme ages and living at high altitude had a higher prevalence of newborns with small phenotypes, and mothers who were wealthier, more educated, and older had a higher prevalence of infants with large phenotypes. Our findings cautiously suggest that socioeconomic and geographic disparities may play a crucial role in shaping vulnerable newborn phenotypes at national and subnational level in Peru. Further studies using longitudinal data are needed to corroborate our findings and to identify individual-level risk factors. Ter Meulen Grant from the KNAW Medical Sciences Fund of the Royal Netherlands Academy of Arts and Sciences (KNAWWF/1085/TMB406, KNAWWF/1327/TMB202116), Fogarty Program (D43TW011502).

Prevalence and correlates of self-reported access to a gun among students at 24 postsecondary institutions by sex and gender identity

Objective Estimate prevalence and identify correlates of self-reported access to a gun among college students. Participants Degree seeking students never serving in the military at 24 postsecondary institutions participating in ACHA-NCHA III during spring of 2020 and 2021 (N = 17,293) stratified by ciswomen, cismen, and transgender/gender nonconforming. Methods Independent variables included measures of individual-level risk behaviors and experiences including interpersonal violence, mental health issues, and current and lifetime substance use. Individual-level demographics, indicators of institutional affiliation, and institutional characteristics used as controls. Descriptive statistics, chi-square tests of independence, and adjusted odds ratios are reported. Results About 14% (n = 2,349) of sample self-reported access. Students’ involvement with multiple different risk behaviors and experiences increased the odds of access. Conclusions Access is a prerequisite to firearm use and resulting on-campus assaults, suicides, and homicides. Additional research on access prevalence, location and type of firearm being accessed, and the correlates of access is needed.

Drinking, Diversity, and Discrimination: Campus-Level Factors that Influence Students' Risk of Experiencing Sexual Assault.

College students' individual-level risk factors for sexual assault victimization have been studied for decades, but fewer studies have looked at whether and how campus-level factors, such as campus-level rates of discrimination and campus diversity, might also influence student victimization risk. Identifying these broader factors can inform efforts to develop more effective campus-level sexual assault preventive interventions. We conducted a secondary analysis of data from a large, multi-campus health and well-being survey (N = 309,171 students across 474 US campuses) to explore how campus-level factors shape students' risk of experiencing sexual assault after accounting for students' individual-level risk factors. Using mixed-effects logistic regression, we examined the influence of campus-level factors (e.g., campus sexual orientation demographics and gender diversity) on students' odds of experiencing sexual assault, after accounting for individual risk factors (e.g., sexual and gender minority status). Although some campus characteristics, such as enrollment size, had small significant effects on students' odds of experiencing sexual assault, we found larger significant effects from aggregated campus-level rates of binge drinking, campus diversity (particularly regarding sexual orientation and gender), and discrimination. These findings suggest that comprehensive campus sexual violence prevention would benefit from strategies that promote safe and inclusive campuses, especially for students with marginalized sexual and gender identities.

Cell-free DNA fragmentomics and second malignant neoplasm risk in patients with PTEN hamartoma tumor syndrome

Individuals with PTEN hamartoma tumor syndrome (PHTS) harbor pathogenic germline PTEN variants that confer a significantly increased lifetime risk of various organ-specific cancers including second primary malignant neoplasms (SMNs). Currently, there are no reliable biomarkers that can predict individual-level cancer risk. Despite the highly promising value of cell-free DNA (cfDNA) as a biomarker for underlying sporadic cancers, the utility of cfDNA in individuals with known cancer-associated germline variants and subclinical cancers remains poorly understood. We perform ultra-low-pass whole-genome sequencing (ULP-WGS) of cfDNA from plasma samples from patients with PHTS and cancer as well as those without cancer. Analysis of cfDNA reveals that patients with PHTS and SMNs have distinct cfDNA size distribution, aberrant genome-wide fragmentation, and differential fragment end motif frequencies. Our work provides evidence that cfDNA profiles may be used as a marker for SMN risk in patients with PHTS.

Apocalypse now or later? Nuclear war risk perceptions mirroring media coverage and emotional tone shifts in Italian news

Abstract This study delves into the progression of nuclear war risk perceptions during the initial 6 months of the Ukraine war. It particularly investigated the influence of Italian media coverage changes and the affective tone of war representation. Utilizing a mixed-methods approach, two separate yet interconnected studies were conducted. The first study employed web scraping and keyword selection techniques to assess emotional language and quantify war-related content in the headlines of Italian online newspapers from March to July 2022. Results demonstrated a linear decrease in war-related news and an emotional shift, with a significant decrease in fear and an increase in joy noted between March and May. The second study examined nuclear war risk perceptions at an individual level, surveying a panel of 397 Italians at three distinct points during the same time frame. The findings revealed a similarity between the media’s affective tone and individuals’ affective risk perceptions. Analytic risk perception, in contrast, showed a linear decrease that matched the decline in war-related news volume. The study found preexisting individual differences, among women and older participants, to be significant determinants in shaping risk perception evolution. These groups exhibited higher initial risk perceptions and more resistance to change as the scenario unfolded. This research contributes to the existing body of work that underscores the media’s role in influencing risk perceptions by illuminating the relationship between media representation of the Ukraine war and individual-level affective risk perception. Furthermore, it highlights individual differences as significant moderators of risk perception change during a crisis.

Why Liver Cancer Hits Home: Bridging Healthcare Disparities in the Asian American and Pacific Islander Community.

Asian Americans and Pacific Islanders have an increased risk of developing liver cancer and higher risk of death compared to non-Hispanic White individuals. The role of individual-level risk factors, social determinants of health, and barriers navigating health systems present unique challenges in obtaining liver cancer care for these patients. Additionally, the Asian American and Pacific Islander population is a heterogenous group originating from several different countries and speaking various languages, and they are often underrepresented in cancer clinical trial populations. This article describes the challenges faced by Asian American and Pacific Islander patients with liver cancer from the clinician, research, and patient advocacy perspectives and proposes targeted solutions to reduce healthcare disparities in this group.

Machine learning identifies risk factors associated with long-term sick leave following COVID-19 in Danish population

BackgroundPost COVID-19 condition (PCC) can lead to considerable morbidity, including prolonged sick-leave. Identifying risk groups is important for informing interventions. We investigated heterogeneity in the effect of SARS-CoV-2 infection on long-term sick-leave and identified subgroups at higher risk.MethodsWe conducted a hybrid survey and register-based retrospective cohort study of Danish residents who tested positive for SARS-CoV-2 between November 2020 and February 2021 and a control group who tested negative, with no known history of SARS-CoV-2. We estimated the causal risk difference (RD) of long-term sick-leave due to PCC and used the causal forest method to identify individual-level heterogeneity in the effect of infection on sick-leave. Sick-leave was defined as >4 weeks of full-time sick-leave from 4 weeks to 9 months after the test.ResultsHere, in a cohort of 88,818 individuals, including 37,482 with a confirmed SARS-CoV-2 infection, the RD of long-term sick-leave is 3.3% (95% CI 3.1% to 3.6%). We observe a high degree of effect heterogeneity, with conditional RDs ranging from −3.4% to 13.7%. Age, high BMI, depression, and sex are the most important variables explaining heterogeneity. Among three-way interactions considered, females with high BMI and depression and persons aged 36–45 years with high BMI and depression have an absolute increase in risk of long-term sick-leave above 10%.ConclusionsOur study supports significant individual-level heterogeneity in the effect of SARS-CoV-2 infection on long-term sick-leave, with age, sex, high BMI, and depression identified as key factors. Efforts to curb the PCC burden should consider multimorbidity and individual-level risk.

Risk perception and interpersonal discussion on risk: A systematic literature review.

Risk perception research has long been attentive to the fact that risk is a social construction. Nevertheless, this fact has not been integrated into empirical research in any systematic manner. Empirical studies that do focus on the social construction of risk often do so from very different positions and with different objectives in mind. Interpersonal discussion, while considered an important medium of social construction, is rarely given consideration. This systematic literature review aims to provide a coherent foundation for empirical studies of interpersonal discussion on risk. Specifically, it summarizes existing research into the reciprocal relationship between interpersonal discussion on risk and individual-level risk perception. The systematic literature review adheres to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A total of 843 unique articles were identified, of which 60 are included in the review. A majority of the articles in the corpus found a positive association between interpersonal discussion on risk and risk perception. This association, however, lacks robustness, especially in terms of the direction of causality. Three theoretical interpretations of the relationship are found in the corpus: (1) interpersonal discussion as a conduit for risk information, (2) risk perception as shared social schemata, and (3) interpersonal discussion on risk as a facilitator of similarity between network members. Implications for future research are discussed. This literature review concludes with six guiding principles for future research into the interpersonal discussion-risk perception relationship.

Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions

Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.